Intersphincteric Resection Is the Optimal Procedure for Very Low Rectal Cancer: Techniques, Morbidity, Oncologic and Functional Outcomes

Introduction: The development of new surgical techniques and devices, as well as the improvements in neoadjuvant chemoradiotherapy enabled intersphincteric resection (ISR), has reduced permanent colostomy usage. The aim of this study was to assess the long-term oncological and functional outcomes of patients who underwent partial ISR for rectal cancer located less than 5cm from the anal verge. Materials and Methods: A series of 106 consecutive patients with very low rectal cancer underwent curative partial ISR from January 2006 to September 2019 were retrospectively evaluated. One-hundred-three (97%) of 106 patients received neoadjuvant chemo-radiotherapy. Overall survival (OS), disease-free survival (DFS), and local recurrence (LR) rates were calculated using Kaplan–Meier methods. The Wexner incontinence score and Kirwan classification were used to evaluate patients’ functional results. Results: The median follow up was 60 months (range, 18–174). The estimated five-year overall and disease-free survival rates were 89% and 81.6%, respectively. Five-year local recurrence and distant metastasis rates were 6.6% and 10.4%, respectively. There was no in-hospital and 30-day mortality. The median Wexner score was 9 (range, 0–20) for 72 patients. Age (<65 years, p=0.027) and gender (male, p=0.019) had a positive effect on functional outcomes after surgery. One and five years colostomy-free survival rates were 96% and 89%, respectively. Conclusion: Intersphincteric resection techniques are feasible for patients with very low rectal cancer, providing good oncological and functional outcomes.

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Risk factors for local recurrence and long term survival after minimally invasive intersphincteric resection for very low rectal cancer: Multivariate analysis in 161 patients

European Journal of Surgical Oncology ◽

10.1016/j.ejso.2021.03.246 ◽

2021 ◽

Author(s):

G.N. Piozzi ◽

H. Park ◽

T.H. Lee ◽

J.S. Kim ◽

H.B. Choi ◽

...

Keyword(s):

Risk Factors ◽

Rectal Cancer ◽

Multivariate Analysis ◽

Local Recurrence ◽

Minimally Invasive ◽

Intersphincteric Resection ◽

Low Rectal Cancer ◽

Term Survival ◽

Very Low Rectal Cancer

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Survival and functional and oncological outcomes following intersphincteric resection for low rectal cancer: short-term results

Journal of International Medical Research ◽

10.1177/0300060518758841 ◽

2018 ◽

Vol 46 (4) ◽

pp. 1617-1625 ◽

Cited By ~ 4

Author(s):

Călin Molnar ◽

Butiurca Vlad-Olimpiu ◽

Botoncea Marian ◽

Togănel Cornelia ◽

Gurzu Simona

Keyword(s):

Rectal Cancer ◽

Survival Rate ◽

Functional Outcomes ◽

Intersphincteric Resection ◽

Low Rectal Cancer ◽

Study Patient ◽

Reference Ranges ◽

Short Term ◽

Wexner Score ◽

Oncological Outcomes

Objective This study was performed to evaluate the 1-year survival rate and functional outcomes of 20 patients who underwent intersphincteric resection (ISR) for low rectal cancer. Methods Twenty patients who underwent ISR for low rectal cancer were followed up for 1 year. Complications, functional outcomes objectified by the Wexner score, and oncological outcomes were assessed. Results The short-term survival rate was 100%. The median Wexner score was ≤10 in all patients at 12 months after surgery. Signs of local recurrence were absent, and antigen levels remained within the reference ranges 1 year postoperatively. Conclusions ISR is a feasible alternative in highly selected patients who primarily refuse a colostomy bag and present with type II or III tumors. In the present study, patient-reported continence was satisfactory, and the absence of a colostomy bag increased patients’ quality of life. The oncological outcomes were satisfactory at 1 year postoperatively.

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Safety and Feasibility of Laparoscopic Intersphincteric Resection for Very Low Rectal Cancer

Journal of Gastrointestinal Surgery ◽

10.1007/s11605-009-1150-x ◽

2010 ◽

Vol 14 (4) ◽

pp. 645-650 ◽

Cited By ~ 36

Author(s):

Yoshiya Fujimoto ◽

Takashi Akiyoshi ◽

Hiroya Kuroyanagi ◽

Tsuyoshi Konishi ◽

Masashi Ueno ◽

...

Keyword(s):

Rectal Cancer ◽

Intersphincteric Resection ◽

Low Rectal Cancer ◽

Very Low Rectal Cancer ◽

Laparoscopic Intersphincteric Resection

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Intersphincteric Resection in Very Low Rectal Cancer

Diseases of the Colon & Rectum ◽

10.1007/s10350-004-0936-x ◽

2005 ◽

Vol 48 (6) ◽

pp. 1324 ◽

Cited By ~ 1

Author(s):

Ahmed Shafik

Keyword(s):

Rectal Cancer ◽

Intersphincteric Resection ◽

Low Rectal Cancer ◽

Very Low Rectal Cancer

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Extended intersphincteric resection with quadrant resection of external sphincter after neoadjuvant mid-course chemoradiotherapy in the very low rectal cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.e14181 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. e14181-e14181

Author(s):

Nahmgun Oh ◽

Sanghwa Ko ◽

Hyunsung Kim

Keyword(s):

Rectal Cancer ◽

Anal Verge ◽

External Sphincter ◽

Postoperative Mortality ◽

Intersphincteric Resection ◽

Low Rectal Cancer ◽

Pelvic Cavity ◽

Group I ◽

Very Low Rectal Cancer ◽

The Mean

e14181 Background: To evaluate the results of extended intersphincteric resection of T3 rectal cancer situated below 4cm from the anal verge, comparing the results of simple intersphincteric resection of T2 rectal cancer after mid-course chemoradiotherapy. Methods: Between 2000 Between 2000 and 2006, 67 patients with rectal cancer below 4cm from anal verge, underwent abdomino-intersphincteric resection reconstructed by inversion proctoplasty with a colonic J-pouch and diverting ileostomy. All patients received a total irradiation dose of 30 Gy with conventional fractions for 3 weeks. Capecitabine was administered 1000mg/m2 twice a day on 21 days during radiotherapy, followed curative surgery in a week without resting period. After preoperative radio-chemotherapy, patients with overt T2 lesion were 27 cases (40.3%) and received intersphincteric resection (Group I: simple intersphincteric resection), and patients with borderline cases or T3 lesion were 40 cases (59.7%) and received intersphincteric resection with quadrant resection of upper external sphincter and primary repair of the external sphincter as inversion proctoplasty (Group II: extended intersphincteric resection). Results: The mean patients age was 61.2 years. The mean location of cancer was at 3.2cm from anal verge (2-4cm). Anastomotic leakage was confirmed in 11 patients (16.4%). There was no postoperative mortality. The grade I, II of continence by Kirwan classification was 81.5%, 80.0% in Group I and II. Under 3 times stool frequency per day was 51.9%, 62.5% in Group I and II. Two patients (3.0%) experienced locoregional recurrence of pelvic cavity. 5-year overall survival rate was 83.6%. Conclusions: Simple and extended intersphincteric resection is seemed to be a safe and functionally acceptable procedure. And, neoadjuvant mid-course chemoradiotherapy using oral capecitabine 2,000 mg/m2/day on 21 days during 2 Gy radiation of each 15 weekdays is seemed to be a tolerable and effective modality, in patients with very low rectal cancer.

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Laparoscopic Intersphincteric Resection With a SILS Port for Very Low Rectal Cancer

Surgical Laparoscopy Endoscopy & Percutaneous Techniques ◽

10.1097/sle.0b013e318248b446 ◽

2012 ◽

Vol 22 (3) ◽

pp. e138-e141 ◽

Cited By ~ 2

Author(s):

Masayasu Hara ◽

Mikinori Sato ◽

Satoru Takayama ◽

Hiroyuki Imafuji ◽

Ryo Ogawa ◽

...

Keyword(s):

Rectal Cancer ◽

Intersphincteric Resection ◽

Low Rectal Cancer ◽

Very Low Rectal Cancer ◽

Sils Port ◽

Laparoscopic Intersphincteric Resection

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Exfoliated cancer cells during intersphincteric resection for very low rectal cancer

Surgery Today ◽

10.1007/s00595-020-02064-w ◽

2020 ◽

Vol 50 (12) ◽

pp. 1652-1656

Author(s):

Yoshikazu Koide ◽

Kotaro Maeda ◽

Hidetoshi Katsuno ◽

Tsunekazu Hanai ◽

Koji Masumori ◽

...

Keyword(s):

Rectal Cancer ◽

Cancer Cells ◽

Intersphincteric Resection ◽

Low Rectal Cancer ◽

Very Low Rectal Cancer

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What Is the Place of Intersphincteric Resection When Operating on Low Rectal Cancer?

ISRN Surgery ◽

10.5402/2012/585484 ◽

2012 ◽

Vol 2012 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Satoshi Nagayama ◽

Waheeb Al-Kubati ◽

Yoshiharu Sakai

Keyword(s):

Rectal Cancer ◽

Functional Outcomes ◽

Recent Literature ◽

Coloanal Anastomosis ◽

Preoperative Chemoradiotherapy ◽

Abdominoperineal Excision ◽

Intersphincteric Resection ◽

Low Rectal Cancer ◽

Rectal Cancers

Operating on low rectal cancer by performing an intersphincteric resection (ISR) with coloanal anastomosis has been adopted as an alternative to abdominoperineal excision (APE) following Schiessel et al. report in 1994, as it preserves the sphincter and avoids the need for a permanent stoma. We undertook a review of the recent literature specifically focusing on long-term oncologic and functional outcomes of ISR to evaluate whether this operation is a valid alternative to an APE. In conclusion, younger patients with T1 or T2 rectal cancers who require no preoperative therapy are ideal candidates for ISR, given that preoperative chemoradiotherapy may cause long-term severe anal dysfunction after ISR.

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